Healthcare Provider Details

I. General information

NPI: 1053945907
Provider Name (Legal Business Name): JENNA KOBLINSKI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2020
Last Update Date: 07/30/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1331 N 7TH ST STE 250
PHOENIX AZ
85006-2722
US

IV. Provider business mailing address

1331 N 7TH ST STE 250
PHOENIX AZ
85006-2722
US

V. Phone/Fax

Practice location:
  • Phone: 602-483-6504
  • Fax: 602-354-5607
Mailing address:
  • Phone: 602-483-6504
  • Fax: 602-354-5607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number76916
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: